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Objective The aim of this study was to explore the fate of moderate ischemic mitral regurgitation (IMR) following isolated coronary artery bypass grafting (CABG). Background IMR is a frequently encountered problem seen in patients with coronary artery disease. A much-debated question is whether surgical revascularization alone will correct moderate (2+) IMR in such patients. Patients and methods The study group included 20 patients with moderate IMR associated with coronary artery disease undergoing isolated CABG. All patients had an ejection fraction of more than 30%. The patients were clinically and echocardiographically evaluated preoperatively, 1 week postoperatively and at 3- and 6-month intervals. Results CABG alone reduced the degree of IMR in 12 (60%) patients, did not improve it in five (25%) patients, and increased its degree to 3–4 + in three (15%) patients at 6-month follow-up echocardiography. Our study showed improved functional capacity of the patients. A significant reduction in the New York Heart Association functional class was observed. The mean preoperative value for New York Heart Association was 2.45 ± 0.51 versus 2.05 ± 0.88 postoperatively (P = 0.042). Some important variables showed a role in the progression of IMR. These were: left ventricular end-systolic dimension, left ventricular end-diastolic dimension, preoperative ejection fraction%, and failure to graft the diseased right coronary system. Conclusion The presence of moderate IMR in patients undergoing revascularization alone does not add additional burden to the operative risk nor does it affect the short-term outcome of these patients.

Objectives The aim of this study was to demonstrate whether transcatheter aortic valve implantation (TAVI) improves mortality and morbidity compared with surgical aortic valve replacement in high-risk patients who require intervention for aortic valve stenosis (AS). Many patients with severe AS and coexisting conditions are not candidates for surgical replacement of the aortic valve. Recently, TAVI has been suggested as a less invasive treatment for high-risk patients with AS. Patients and methods Fifty patients with severe AS for aortic valve intervention were classified as follows: group A, as TAVI group, included 25 patients who underwent aortic valve replacement by transcatheter femoral approach, and group B, as surgical aortic valve replacement group, included 25 patients who underwent aortic valve replacement by median sternotomy. Results Intraoperatively, procedure duration was 101.8 ± 10.6 and 191.2 ± 7.5 min in group A and B, respectively (P Conclusion In high-risk patients with severe AS, transcatheter and surgical procedures for aortic valve replacement were comparable for survival at 3 months, although there were important differences in periprocedural outcomes.

Objective To evaluate the risk factors affecting the early outcome of surgical treatment of infective endocarditis (IE). Background IE represents a series of clinical conditions with high in-hospital mortality, so early diagnosis and treatment can improve outcomes. Diagnosis depends on constant history and classic manifestations like sustained bacteremia or fungemia or active valvulitis. IE is a medical-surgical disease in which surgical treatment is a part of the therapeutic process rather than a result of the failure of medical treatment. Patients and methods A prospective cohort study was conducted on 50 consecutive patients diagnosed with definite IE and underwent cardiac surgery after being admitted to the Cardiothoracic Surgical Department, National Heart Institute, Giza, Egypt, during the period from December 2015 till March 2017. Preoperative, intraoperative, and postoperative data as potential predictors of mortality were tested. Results Our results showed that rheumatic heart disease was the most common underlying cardiac disease. Native valve endocarditis was present in 31 (62%) and prosthetic valve endocarditis in 19 (38%) patients. Mean Euro SCORE II was 5.71%. The hospital mortality was 22%, whereas the 6-month mortality was 10%. Congestive heart failure, embolization, and periannular extension of infection are the most powerful predictors of hospital mortality and also 6-month mortality. Conclusion Surgery for IE continues to be challenging. Euro SCORE II has a good discrimination ability to predict in-hospital mortality in IE surgery. Satisfactory results can be obtained with valve repair in IE.

Objective This study aims to compare the efficacy of mitral valve surgery with left atrial maze versus isolated mitral valve surgery. Background Atrial fibrillation (AF) is the most common arrhythmia in clinical practice, especially with mitral valve disease. It represents a significant health burden especially with the associated thromboembolic complications. Several surgical approaches have been developed. The most effective one is Cox-Maze III procedure using cut-and-sew technique. Recently, surgical ablation has been transformed into an easier and faster procedure using radiofrequency, microwave, and cryothermal energy. Patients and methods This is a prospective cohort study conducted after the approval of the Human Ethics Committee of Faculty of Medicine, Menoufia University. A total of 100 patients with permanent AF and concomitant mitral valve disease have been recruited. The patients were allocated into two equal groups. Group A included mitral valve surgery and left atrial maze procedure, whereas group B included mitral valve surgery without left atrial maze. Results Group A had significant longer bypass and clamp times than group B (P Conclusion Left atrial maze with mitral valve surgery results in a better outcome in terms of myocardial function and dimensions. In addition, sinus rhythm restoration has the potential benefit of reducing the incidence of thromboembolic complications.

Objective The objective of this study was to evaluate tricuspid valve (TV) ring annuloplasty for moderate functional tricuspid regurgitation (FTR) in patients undergoing mitral valve (MV) surgery. Background TV ring annuloplasty during MV surgery for severe FTR is recommended but for moderate FTR is controversial. Patients and methods Eighty patients with moderate FTR who were listed for MV surgery were classified into group A, the TV annuloplasty group which included 34 patients who underwent MV surgery and TV annuloplasty and group B, the TV nonrepair group, 46 patients who underwent MV surgery alone. Results At 1-month follow-up, in group A: no, mild, and severe FTR were detected in 70.6, 26.5, and 2.9% of patients, respectively, whereas in group B, no, mild, moderate, and severe FTR were detected in 26.1, 58.7, 13, and 2.9% of patients, respectively (P = 0.001). Pulmonary artery pressure (PAP) in groups A and B was 27.2 ± 5.1 and 31.7 ± 6.8 mmHg, respectively (P = 0.001). At 6-month follow-up, in group A no, mild, and severe FTR were detected in 64.7, 32.4, and 2.9% of patients, respectively, whereas in group B, no, mild, moderate, and severe FTR were detected in 32.6, 50, 15.2, and 2.2% of patients, respectively (P = 0.01). PAP in groups A and B was 27.6 ± 5.1 and 32.2 ± 7.1 mmHg, respectively (P = 0.003). Conclusion Intervention for moderate FTR is recommended during MV surgery to avoid persistence or progression of the TR especially in patients with high PAP.